Sleep Issues and Depression
Depression and sleep deprivation often go hand in hand. Depression is exacerbated by sleeplessness and vice versa. Left untreated these issues can worsen and cause further health concerns.
Effects of depression and poor sleep
Depression comes in varying levels of severity but all should be attended to by a qualified health professional. There is a wide range of sleep issues an individual might experience in conjunction with depression including chronic insomnia, circadian rhythm sleep-wake cycle disorders, or parasomnias.
Experiencing sleep disturbances and depression is difficult for both the patient and family members and/or caregivers. These conditions may affect the patient and loved ones in new ways that they have not encountered with previous or other current health concerns. Becoming aware of these effects can help both patient and family adjust and prepare for care.
1. Effects on patients
Patients can expect to experience certain symptoms from depression, however, it should be noted that depression does not manifest the same in every person. For this reason, it is important to see a qualified health professional who can assess the condition if you suspect that you or your loved one may be experiencing depression. According to the Anxiety and Depression Association of America common symptoms and causes of depression include:
- Persistent sad or anxious feelings
- An “empty” mood
- Moderate daytime sleepiness
- Disturbance to the sleep-wake cycle
- Pessimism or hopelessness
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest in previously enjoyed activities
- Loss of sexual interest/drive
- Chronic fatigue, lack of energy
- “Brain fog”, difficulty concentrating or making decisions
- Poor memory recall
- Restless leg syndrome
- Chronic Insomnia, waking up early, oversleeping
- Low appetite and weight loss or overeating and weight gain
- Suicidal thoughts and/or attempts
- Difficulty to fall asleep
- Post-traumatic stress disorder (PTSD)
- Restlessness and irritability
- Sleep-related breathing disorders
- Excessive daytime sleepiness
- Trouble falling asleep
- Low sleep quality
- Disruptive sleep patterns
- Reduced REM sleep
- Persistent physical symptoms that cannot be explained by another diagnosis such as headaches, digestive orders, or other pain
While all of these symptoms are possible, it is likely that not all will be experienced or apparent. Many patients can remain high functioning while still experiencing symptoms of depression.
In addition to the physical and mental symptoms, it is likely that depression will affect a patient’s everyday life in other ways or as a result of depressive symptoms. Some patients may experience a decline in productivity at work, social isolation including intentional isolation or non-participation, poor management of finances, poor hygiene, lack of self-care like dressing well, exercising, or choosing a poor diet, and overindulgence in comforting activities like staying in bed or watching television.
2. Effects on loved ones
Depression can also be an extremely difficult issue for the family members of the depressive patient. Unlike apparent physical conditions, mental health issues can be harder to address and assess to determine possible care needs. This can lead to feelings of stress and helpless in caring for your loved one. Major depression in a loved one can also leave family members feeling guilty, frustrated, or even isolated as the depressive loved one may begin to neglect relationships and lack emotional connection.
Lack of ambition or professional drive may cause a patient’s income to decrease or cease altogether putting additional financial burdens on the family if the patient was still working during the onset of depression or as the condition has worsened. Any care the patient may need, such as psychological assessment and therapy, may become the financial responsibility of family members as well.
Managing care such as therapy visits or medication will require additional time from family members or caregivers. In some cases of extreme need managing a patient’s care can alter family members’ lifestyles and even become a full-time job.
Meeting the emotional needs of a depressive patient can take a tremendous toll on family members. Family members may feel emotionally drained after caring for their loved one or frustrated at their inability to emotionally connect. In the case of spousal depression, intimacy may fade quickly. Maintaining a connection with someone who is depressed can be very hard and even impossible at times in the ways you were able to connect before and this will affect not only closest family members and caregivers but their families as well. A “trickle-down effect” of emotional exhaustion is not uncommon.
3. Poor sleep exacerbates depression
As mentioned above, sleep disturbances and depression are two separate issues and they may be experienced independently. However, in many cases, the two issues occur simultaneously and affect each other’s severity. When a patient does not sleep enough they may experience:
- Anxiety disorders and paranoia
- High less of stress and poor stress regulation
- Abnormal heart and metabolic rates
- Increased risk of heart issues, hypertension, and Type 2 diabetes
- Cognitive impairment, “brain fog”, inability to make decisions
- Poor decision making
- Poor performance at work or in hobbies
- Poor general health
Many of these symptoms overlap with depressive symptoms. If the patient is experiencing both sleep issues and depression it can be hard to determine which symptom is caused by or is affecting which issue. In this case, a comprehensive approach to care may be best.
Many of effects depression has on family members are also present when a loved one has sleep issues. Family members can expect to see a decline in work performance, social activity, ability to keep up with responsibilities, self-care, and health which may lead to additional time and care to be given to the patient.
Organizations for mental health
There are many organizations and nonprofits available to turn to for support and information if you or a family member are experiencing sleep issues and/or depression. These organizations provide a great starting place to begin to understand disruptive sleep patterns and depression and how to care for someone with these issues. In addition to these groups, it is always best to confer with a health care provider.
1. National Alliance on Mental Health
The National Alliance on Mental Health (NAMI) is a large health network that seeks to provide individuals and families suffering from mental illness with resources, information, and support. The National Alliance on Mental Health provides education programs, advocates for public policies that benefit mental health patients, provides a telephone helpline for those seeking advice or information and offers support groups for both patients and family members. You can visit their website at nami.org, call the helpline at 800-950-NAMI, email the helpline at firstname.lastname@example.org, or text “NAMI” to 741741.
2. American Psychiatric Association
The American Psychiatric Association is made up of psychiatrists and it seeks to provide resources to those suffering from mental illness or substance abuse. Their website, Psychiatry.org, provides information on many different types of mental illness including both depression and sleep issues. The website also includes a tool to help you find a psychiatrist in your area. You can message them through the Contact Us tool on their website or through their customer service line at 888-35-PSYCH.
3. Anxiety and Depression Association Of America
The Anxiety and Depression Association of American is an organization boasting both clinicians and researchers and seeks to provide information on scientifically backed treatment options for a number of mental health concerns including sleep disorders and major depressive disorder. In addition to providing information about these illnesses on their website, they provide a tool to locate a therapist in your area and find a local support group. You can visit their website at adaa.org, email them at email@example.com, or call at 240-485-1001.
4. Families for Depression Awareness
Families for Depression Awareness focuses on the well being of families facing depression. They provide resources for understanding mood disorders and how to help someone with a mood disorder. You can visit their website at familyaware.org, call them at (781) 890-0220, or email them at firstname.lastname@example.org.
5. Finding more organizations
Aside from a quick internet search and word of mouth, the best place to find the reliable support that you can trust to disseminate accurate and helpful information is by asking your health care provider. Dealing with sleep disorders and depression can be difficult but choosing the right care and support can be a huge help in managing and healing.
Care needs for sleep issues and depression
As mentioned above, sleep problems and depression require different care than that of a physically apparent illness or disability. There are unique short-term and long-term needs that should be taken into consideration when assessing care for yourself or a family member.
1. Short-term needs
If you suspect that you or a family member may be suffering from a sleep disorder and/or depression talk to someone you trust. Just putting words to the issue can be a big first step in making positive changes. Next, it is important to locate a care provider who can assess your health. (If you are unsure about how to find and choose a provider. See the section below on how to identify the right care provider.) In the following days and weeks your loved one may need:
- Transportation to and from care appointments
- Medication management and administration
- Increased supervision as they adjust
- Help keeping up with everyday responsibilities like bills, shopping, and meal planning
- Time off from work or other obligations
2. Long-term needs
After a patient’s level of health has been addressed by a qualified professional and the patient has begun a regimen of therapy and/or medication there may additional long-term needs in the following months and years.
- If the patient is unable to return to work in their previous capacity or require care and medication they are unable to afford they may have financial and legal needs, addressed below
- The patient may need continued monitoring of their medication and adherence to therapies or another care regimen if they are unable to maintain consistency on their own
- They will need emotional support- dealing with a sleep disorder and/or depression can be very emotionally and physically draining, frustrating, and confusing
- The patient may be unable to live alone due to either or both financial and physical needs
Financial and legal needs
Because depression and sleep problems can have a profound effect on an individual’s ability to work they may experience a steep decline in income. Even if an individual has retired from the workforce at the time of their diagnosis the amount and quality of care required by their condition may bring new financial or legal needs.
- The patient may need help affording and managing payment for everyday expenses like housing, food, and transportation
- The patient may need help paying for therapies, care appointments, and medications that are not covered by insurance
- If the patient has a short-term or a long-term stay in a mental health facility insurance may not cover all of the costs
- The patient may need help paying for an maintaining any other obligations or investments such as real estate, child care, pet care, or monetary investments
- The patient may need to cancel a lease on a car or apartment or consider selling their home to pay for care if they are no longer able to live alone
- If they have debts they are unable to pay they may face litigation from creditors
- If their sleep disorders or depression has progressed in such a way that they are unable to make decisions for themselves the patient may need a power of attorney
Supporting a loved one with depression
If you are a family member of a depression or sleep disorder patient there are steps you can take to help the patient in their journey.
- You can talk to them about behaviors you have noticed if they are unaware of the problem themselves in an encouraging and loving way
- You can listen to the feelings they may have about their disorder
- You can assure them that you will be a partner and a supporter as they seek health
- You can them to find a health care provider and encourage treatment
- Encourage a routine
In the case of patients who are unwilling to admit they might have depression or a sleep disorder, it is important to be patient but persevering in your encouragement that they should be assessed. Most of the time patients will agree to meet with their regular physician if they are unready to meet with a mental health professional.
Finding the right care provider
Finding the right provider can be an unwanted stress in an already difficult situation. A great place to start for those unfamiliar with depression and sleep problems is with your current care provider. This may be your family doctor or general practitioner. In many cases, your current care provider will be able to recommend the next step.
If you do not have a current health care provider you can visit one the websites mentioned above or similar sites that have tools to locate mental health or sleep disorder specialists in your local area.
It is important to note that the first care provider you meet with may not be the one you should choose. Additionally, a patient may not stay with the same care provider throughout their treatment or the duration of their disorder. As a patient’s needs change they may find that they no longer agree or feel comfortable with their provider and may want to seek a new one. In the case of depression and sleep disorders (like sleep apnea and insomnia), the patient needs to feel comfortable with their care provider and be able to develop trust.
For some patients, mental health issues will be more emotionally challenging to navigate so it will be important to find a care provider that can put the patient at ease, guide the patient through any confusing questions, and that the patient can be honest with about their health needs.
Here are some questions to ask about potential care providers that may help you in choosing the right one?
- What is the provider’s background in treating depression/ sleep problems? Are they licensed?
- What is their specialty in the area of depression/ sleep disorders? (For example: Do they only treat childhood depression? Do they only treat certain types of sleep disorders- will they only treat patients with insomnia but not sleepwalking?
- Will they be able to provide the care the patient may need? (e.g. psychologists and licensed social workers can only provide counseling while psychiatrists can also prescribe medications.)
- Are they in the patient’s insurance network? If they are, what will be the expenses that insurance may not cover?
- Does the patient feel that they can speak to the care provider genuinely?
- What types of treatment do they commonly prescribe for the patient’s condition and is the family/ patient comfortable with that treatment?
- Do they have availability? Will they be able to see the patient as much as needed?
Sleep issues and depression FAQs
1. How do I determine if the patient’s depression or sleep issue is serious enough to see a doctor?
While everyone experiences periods of sadness, low mood, restlessness, or poor sleep throughout their life, depression and sleep disorders are not a normal part of aging. Determining when a patient should see a doctor for depression or sleep problems is more subjective than if the patient had a visible sore or a fever, so the process can be confusing. The safest option is to always see a care provider who can accurately assess the patient’s condition. In one outcome the doctor may assess the patient and send the patient home with a healthy diagnosis. In another outcome, the patient can begin the road to treatment and recovery. Both outcomes are favorable to not knowing for sure.
2. Is it possible that the patient is sleeping poorly simply from bad habits?
There’s no doubt that drinking coffee late in the evening or watching a very bright television or computer screen before bedtime can make it hard to fall asleep. Perhaps the patient sleeps in late and therefore maybe isn’t tired when bedtime comes. Even if these circumstances are playing a role in a patient’s ability to sleep well it is best to have the situation addressed and monitored by a professional. Especially if the patient has tried to stop these habits in the past. It can be the case that the habits developed after or because of an underlying sleep issue. A care provider will be able to assess any underlying conditions and provide tools, resources, therapies, or medication that the patient may need. The patient and family may find that after being treated by a professional that the habits may die out as their condition improves!
3. Can a patient experience depression and a sleep disorder in conjunction with other illnesses or disorders?
Unfortunately, yes. In fact, experiencing additional conditions is very common. Patients may find that they also feel a great deal of anxiety or other mood disorders or may start to have physical health issues or pain like indigestion. A patient’s health is very much connected- as one issue begins to heal other issues may begin to improve. However, it is important to keep your health care provider up-to-date on all symptoms the patient is experiencing since some of these may be due to new medications or therapies.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.